Africa's hidden killers

1 January 2000

‘Rows of children lie on small beds, slowly passing away from preventable diseases like TB, malaria and pneumonia’

‘The problem with taking a blood sample for your malaria test is that the cockroaches may eat it in the night,’ announced the nurse. ‘Ants are an even worse problem. The place is infested with them.’ Siavonga Hospital, on the shores of Lake Karibe in southern Zambia, is suffering. ‘We have to put patients with TB in the same room as women who are giving birth,’ says one of the four Cuban doctors who battle to run the place. They also have to charge fees for their healthcare and patients have to provide their own medicines, syringes and clean needles. What if they can’t afford to pay? The doctor shrugs. ‘What do you think? They die.’

People are dying. Quietly, but in huge numbers, all over Zambia. Not because of some accident of nature but as a direct result of economic policies imposed by faceless Western planners. For over 20 years the World Bank and the International Monetary Fund have been forcing Structural Adjustment Programmes (SAPs) on the bankrupt countries of Africa, blind to the havoc they are causing. Almost every country on the continent has succumbed.

‘If you want to see the impact of structural adjustment,’ says Emily Sikazwe, director of the antipoverty group Women for Change, ‘go to University Teaching Hospital.’

UTH is the city’s biggest, where those who can’t afford private healthcare end up. In a packed ward near the main entrance a man writhes in bed. ‘I’m dying,’ he moans while his wife stands helplessly by his side. Emaciated figures shiver under sparse bedclothes. Families crowd around, many of them on the floor, bringing food to the sick to supplement the meagre hospital rations of beans and maize meal.

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Enter the children’s ward and the smell hits you like a wall – a musty, medicinal odour. Rows of children lie on small beds, slowly passing away from preventable diseases like TB, malaria and pneumonia.

On the other side of the building is a cleaner, neater ward where half the beds stand empty. This is the fee-paying section where families who can pay a 100,000 kwacha ($40) deposit can buy a slightly better chance of life. In World Bank language, this is ‘user-responsive healthcare’.

Esnart Banda and her daoughter: working for pennies in the local market she can afford only one meal a day for her five children.

Mark Lynas

Meanwhile in Misisi, one of the 20 or so shanty ‘compounds’ that ring Lusaka, Masauso Phiri stands outside the windowless concrete shed that is his house. Next door an old man nearly died of starvation – luckily he was saved by the return of his son from the Copperbelt. Mr Phiri, like many of his neighbours, has heard of structural adjustment. It was because of structural adjustment that he lost his job as a security guard and one of his children – a three-year-old boy who died of pneumonia in 1996.

‘I know it is meant to put the economy on the right track but to me it seems to make us suffer,’ he says.

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Four out of five people in Misisi are unemployed, part of an army of jobless created when economists from the World Bank and IMF decided that Zambia’s public sector was ‘bloated’ and that companies would benefit from the tonic of privatization, an ‘opening’ of markets to international competition. The Zambian Government boasts that it has the speediest privatization programme in Africa. But half the companies sold are now bankrupt.

In their desperation people turn on each other: crime is soaring in the compounds around Lusaka. I attended the funeral of one old woman, shot in her house by ‘bandits’ as she tried to prevent them entering. In the darkness outside her house male friends and relatives sit around the fire in quiet contemplation. They will spend the night there, in the cold, just sitting, talking and remembering. Inside the house women wail. The robbers took nothing. The old woman had nothing to take.

‘SAPs cause poverty,’ says Emily Sikazwe. ‘And poverty has a woman’s face.’ Women shoulder the main burden of providing for families and girl children are the first to be withdrawn from school when a father loses his job. Women like Esnart Banda, a widow with five children who makes about 2,000 kwacha ($0.60) a day selling vegetables in a market near Misisi. Most days she can only afford one meal for her children, even though the youngest is suffering from TB. Her kids join the 40 per cent of Zambia’s child population suffering from chronic under-nutrition.

In the midst of this chaos what remains of the nation’s wealth is being plundered. ‘They say if you perform well there’ll be a flow of foreign direct investment,’ says Fred M’membe, editor of Zambia’s daily newspaper, The Post. But all investment is not necessarily good. Take Shoprite, the South African supermarket chain that is colonizing the country on the back of a massive government tax rebate. Shoprite has laid waste to the economies of entire towns, undercutting local traders and putting stores run for generations by one family out of business. To make matters worse, Shoprite buys nothing locally. Their tax-free produce – even maize and potatoes – is trucked in from Zimbabwe and South Africa. Meanwhile Zambian maize rots in the fields because the farmers who grow it cannot find a market.

‘Africa can only develop with the participation of its own people,’ says Emily Sikazwe. People-centred development: that’s the idea Zambian citizens’ groups are focusing on in their newly launched Campaign Against Poverty. They are demanding that Africans be allowed to participate in deciding how their countries are run. But if IMF and World Bank economists are to respect this demand they will have to leave their plush offices in Washington. They’ll have to visit Lusaka, Nairobi and, if they’re serious, University Teaching Hospital and Misisi. And for once, they’ll need to listen to what people there say.

*Mark Lynas* works with Oneworld.net in Britain. He visited Zambia last August.